Training to acquire psychomotor skills for endoscopic endonasal surgery using a personal webcam trainer

Clinical article

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Object

Existing training methods for neuroendoscopic surgery have mainly emphasized the acquisition of anatomical knowledge and procedures for operating an endoscope and instruments. For laparoscopic surgery, various training systems have been developed to teach handling of an endoscope as well as the manipulation of instruments for speedy and precise endoscopic performance using both hands. In endoscopic endonasal surgery (EES), especially using a binostril approach to the skull base and intradural lesions, the learning of more meticulous manipulation of instruments is mandatory, and it may be necessary to develop another type of training method for acquiring psychomotor skills for EES. Authors of the present study developed an inexpensive, portable personal trainer using a webcam and objectively evaluated its utility.

Methods

Twenty-five neurosurgeons volunteered for this study and were divided into 2 groups, a novice group (19 neurosurgeons) and an experienced group (6 neurosurgeons). Before and after the exercises of set tasks with a webcam box trainer, the basic endoscopic skills of each participant were objectively assessed using the virtual reality simulator (LapSim) while executing 2 virtual tasks: grasping and instrument navigation. Scores for the following 11 performance variables were recorded: instrument time, instrument misses, instrument path length, and instrument angular path (all of which were measured in both hands), as well as tissue damage, max damage, and finally overall score. Instrument time was indicated as movement speed; instrument path length and instrument angular path as movement efficiency; and instrument misses, tissue damage, and max damage as movement precision.

Results

In the novice group, movement speed and efficiency were significantly improved after the training. In the experienced group, significant improvement was not shown in the majority of virtual tasks. Before the training, significantly greater movement speed and efficiency were demonstrated in the experienced group, but no difference in movement precision was shown between the 2 groups. After the training, no significant differences were shown between the 2 groups in the majority of the virtual tasks. Analysis revealed that the webcam trainer improved the basic skills of the novices, increasing movement speed and efficiency without sacrificing movement precision.

Conclusions

Novices using this unique webcam trainer showed improvement in psychomotor skills for EES. The authors believe that training in terms of basic endoscopic skills is meaningful and that the webcam training system can play a role in daily off-the-job training for EES.

Abbreviations used in this paper:EES = endoscopic endonasal surgery; VR = virtual reality.

Article Information

Address correspondence to: Yasunori Fujimoto, M.D., Ph.D., Department of Neurosurgery, Kochi Medical School, Kochi University, Oka-cho Kohasu, Nankoku-shi, Kochi 783-8505, Japan. email: yasufujimoto@gmail.com.

Please include this information when citing this paper: published online January 18, 2013; DOI: 10.3171/2012.12.JNS12908.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Photograph of our webcam box trainer, composed of a webcam, laptop computer, flexible arm, and acrylic boards (A). Each neurosurgeon was required to perform 2 basic tasks (B), that is, peg transfer as Task 1 (C) and instrument navigation as Task 2 (D). Photograph of the LapSim VR simulator, which was applied for objective assessment of the skill of each neurosurgeon on pre- and posttraining (E).

  • View in gallery

    Bar graphs showing changes in mean performance scores for each virtual task between pre- and posttraining. For the novice group (upper), significant improvement after webcam box training was found on all tasks except instrument misses (*p < 0.05; **p < 0.001). For the experienced group (lower), significant improvement after the training was found only in instrument path length in the right hand (*p < 0.05). White bars indicate before training; gray bars, after training. S = score.

  • View in gallery

    Bar graphs showing comparisons between the novice (white bars) and experienced (gray bars) groups in mean performance scores for each virtual task before (upper) and after (lower) the training. The mean scores for the experienced group before training (upper) were equal or superior to those of the novice group in all virtual tasks, and significant differences were found in instrument time, instrument path length (Lt), instrument angular length, tissue damage, max damage, and overall score (*p < 0.05; **p < 0.001). After the training (lower), the mean scores of the experienced group were equal or superior to those of the novice group in all virtual tasks; however, no significant differences were found except in the instrument angular length and overall score (*p < 0.05).

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